Write-up: Information has been received from a physician and a registered nurse concerning a 27 year old female with narcolepsy and migraines and a history of cervical dysplasia and papilloma viral infection, and no known allergies, who on 14-Aug-2006 was vaccinated intramuscularly in the left deltoid with the first dose of Gardasil vaccine (yeast) (lot#653937/0637F). Concomitant therapy included "a medication for narcolepsy", Imitrex tablets, Excedrin Migraine, Aviane and dextroamphetamine. On 14-Aug-2006, following the vaccination, the patient experienced flu-like symptoms, nausea, hot and cold sensations, weight loss, decreased energy, cold respiratory symptom, dry skin, and a taste of iron in her mouth. On 04-Oct-2006, the patient was seen by her primary care physician and her white blood count was noted to be within normal range. The patient received the second dose of Gardasil vaccine (yeast) in the right deltoid on 20-Oct-2006. On 14-Dec-2006 the patient called her physician''s office and stated that she was experiencing the same type of flu-like symptoms and thought it was related to the vaccine. At the time of this report, the patient had not recovered . Unspecified medical attention was sought. The nurse reported that the patient missed work or school due to the symptoms, however the nurse did not feel the events were serious. It was recommended to the patient not to receive the third dose of Gardasil vaccine (yeast). Additional information has been requested. This is in follow-up report (s) previously submitted on 1/16/2007. Incormation has been received from a physician and regeistered nurse concerning a 27 year old female teacher with narcolepsy and migraines and a history of cervical dysplasia and papilloma viral infection, and no known allergies, who on 14-AUG-2006 was vaccinated intramuscularly in the left deltoid with the first dose of GARDASIL (lot # 653937/0637F). There were no illnesses at the time of vaccination. Concomitant therapy included sumatripan succinate (IMITREX TABLETS), acetaminophen-aspirin-caffeine (EXCEDRIN MIGRAINE), AVIANE and dextroamphetamine. On 15-AUG-2006, following the vaccination, the patient experienced flu-like symptoms, nausea, hot and cold sensations, weight loss of 5-7 pounds, decreased energy, cold respiratory symptom, dry skin, and a taste of iron in her mouth. On 04-OCT-2006, the patient was seen by her primary care physician and laboratory findings revealed a low red blood cell count of 4.06, a high mean corpuscular volume (MCV) of 97.5, a prothrombin time of 13.1 seconds, and a international normalized ration of 1.2. The patient''s white blood was to be within normal range. On 20-OCT-2006, the patient was vaccinated with the second dose of GARDASIL (0.5 ml) (lot # 653937/0637F) in the right deltoid. On 14-DEC-2006 the patient called her physicain''s office and stated that she was experienceing the same symptoms and thought it was related to the vaccine. At the time of this report, the patient had not recovered. The nurse reported that the patient missed a day of work due to the symptoms, however the nurse did not feel the events were serious. It was recommended to the patient not to receive the third dose of GARDASIL. No further information is expected.